The photoactivating agent UVADEX (methoxsalen) is used in conjunction with extracorporeal photopheresis (ECP) as an immunomodulatory therapy approved for the treatment of cutaneous T-cell lymphoma. ECP involves collecting whole blood from the patient, separating white blood cells (WBCs) via centrifugation, combining them with UVADEX, and then exposing them to ultraviolet A (UVA) light. All blood components, including the treated WBCs, are then returned to the patient. Immune Checkpoint inhibitor (ICI) therapy is used to treat different types of cancer, and one major side-effect of ICI therapy is immune-related colitis (ir-colitis). The main purpose of the study is to evaluate the efficacy of UVADEX in conjunction with ECP versus best available therapy (BAT) in participants with melanoma or NSCLC that suffer from ir-colitis with inadequate response to steroids.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Sterile solution used in conjunction with photopheresis procedure.
Infliximab will be administered intravenously.
Vedolizumab will be administered intravenously.
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Proportion of Participants with Remission of ir-colitis at End of Treatment
Composite endpoint of remission measured by diarrhea frequency (CTCAE grade 0 or 1 at Week 12) and colonic mucosal endoscopy score (modified Mayo Score 0 or 1 at Week 13).
Time frame: Week 12 (diarrhea frequency) / Week 13 (colonic mucosal endoscopy score)
Total Duration of Remission for ir-colitis Based on the Criteria for Diarrhea
Duration of remission is the time from when diarrhea improves until the time it comes back (if it does).
Time frame: Week 64
Proportion of Participants with Complete Resolution of Diarrhea
Complete resolution of diarrhea refers to normal stool frequency.
Time frame: Week 12
Proportion of Participants with Complete Resolution of Colonic Endoscopic Changes
Complete resolution of colonic endoscopic changes refers to no signs of inflammation or damage in the colon.
Time frame: Week 13
Proportion of Participants with Corticosteroid-free Clinical Remission
Corticosteroid-free clinical remission is assessed based on the absence of diarrhea and daily corticosteroid dose \<5 mg prednisolone or equivalent at week 12.
Time frame: Week 12
Changes in the Nancy Score
The Nancy histological index comprises 3 histological items defining 5 grades of disease activity: Grade 0 is absence of significant histological disease; Grade 1 is chronic inflammatory infiltrate with no acute inflammatory infiltrate; Grade 2 is mildly active disease; Grade 3 is moderately active disease; and Grade 4 is severely active disease.
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Time frame: Week 13
Proportion of Participants with Stool Calprotectin Level <150 micrograms per gram (μg/g)
Time frame: Week 26
Proportion of Participants with Complete Resolution of Other Symptoms of ir-colitis
Time frame: Week 64
Time to Complete Resolution of ir-colitis Based on Common Terminology Criteria for Adverse Events (CTCAE) Criteria for Colitis
Time frame: Week 64
Time to Complete Resolution of Other Specified Immune-related Adverse Events (irAEs) (other than ir-colitis)
The other specified irAEs may include pruritis, rash, inflammatory dermatitis, esophagitis, gastritis, hepatitis, pneumonitis, arthritis, myositis, polymyalgia and nephritis.
Time frame: Week 64
Time to Complete Discontinuation of Systemic Corticosteroids for at least 1 Week
This is the time taken by a participant to stop using systemic corticosteroids entirely for at least one week.
Time frame: Week 12
Progression Free Survival (PFS) for Melanoma and NSCLC
The approximate time from the start of treatment until the first incidence of cancer worsening or participants dying due to any cause.
Time frame: Week 64
Overall Survival (OS)
The approximate time from the start of treatment until death due to any cause.
Time frame: Week 64